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_ _ _ I ------- --------- ---------------------------------_-_.I�. APPLICATION FOR SANITATION PERMIT Permit No. _46_ -------------•------------- ------------- -•-------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .........ls ' Z12 - tk%--aS Application is hereby made tol the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in cor ipliance�with County Ordinance . 549. JOB ADDRESS AND,•LOCATION.._4 may,,• Owner'sName ---__-------...... 14yt/.. . � -------------- ------ Phone...........-------z................. Address-------------- - ... a ---- --------------- •----- Contractor's Name.................. --------- ............. Phone................................... Installation will serve: Residence ❑ A artment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ 1 Number of living units:�p--...__ umber of bedrooms .__- N tuber of bath Lot size __... _. _ .. } s .. . �� `1`�" Water Supply: Public system ❑ Community system ❑ Priv e�ept 'atterrTable ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay,❑ Adobe Hardpan ' Previous Application Made: (If yes,dcite_/�.6. _ _._.l 'No w Construction: Yes � No ❑ FHA/VA: Yes ❑ NoQ1 TYPE OF INSTALLATION AND SPECIFICATIO S: rt (No septic tank or cesspool permitted if public sewer i;available within 200 feet.) Septi Tank: Distance from nearest well-0stance from foundation.__ ___ No. of partments-------3-----------------$ize_ X( •• -• �-?�---`cam-..:---Liquid depth------•- ;---Z-� Capacity.. ...... ! Disposal Fields Distance from nearest wellistance from foundation-_ r.........Distance to nearest lot/line. ........ Number of lines--------/-------------------- -- Length of each line----100-----1i----------Width of trench--,-. ------of filter material�� , -_Depth of filter material---I?-------------Total length-----..10--p_---_---------------- Seepage -_..._._-_------.--v See❑a a Pit: Number to nearest well---------------------.Distance from foundation....................Distance to nearest lot line.................. � I P9 pits---------------•------Lining material.----------------------Size: Diameter------------•--------.'Depth--------------------------------- Cesspool: Distance froom nearest well-----------------Distance from foundation--------------------Lining material.............._......_ =- Size: Diameter------------------------ --------------- -- Depth Liquid Capacity ................gals. Privy: Distance from nearest well------- ------------------------- T_.-_--Distance from nearest buildint ---- ❑ Distance t8!nearest lot line Remodeling and/or repairing (describe):.___--_.-Mc�,-_- -----_---_- I .. . (?_.. ...._ _. ... -----•....------- . ..t � - - ---------------------------•---------------•---------------------------------------- ----------- ----•----•----------•-----------------------------------•-------•----------•---•------•---------•----------••--•-•-••------•-----•----•-----------••------•-•----------•--- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed)' � � = -----------------------------(Owner and/or Contractor) By:.--•---------------- ---- I�'.. . --------------• -------------------- Title _ (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .. BY1I----------- - �# DATE.. x w 'REVIEWED BY -- ---------- DATE------ r ---�......-••- EJILDING PERMIT ISSUED-------------••--------------------•------------------- -- -•-------�- ------------ DATE------....----•- -•••------------- -- ----------- A Alterations and/or recommendations:______...________________ ------- -.----- i ----------------•-------•---------- ---•---------------------------------- ........................................................... ----••-•----------------••------•-----•------•--- " --------------- FINAL INSPECTION BY:. Date------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 203 West 9th street Stockton,California Lodi,California Manteca,California Tracyr California EE 9 REVISED 6-89 9M 5-61 ATLAS